MEDICARE: CRANDALL HOME CARE OF ARIZONA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1326998758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANDALL HOME CARE OF ARIZONA LLC

Provider Business Mailing Address
First Line	:	PO BOX 66539
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87193-6539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W BROWN RD STE 3A1
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3221
Country	:	US
Telephone Number	:	505-266-6683
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE TRACY
Credential	:
Telephone Number	:	505-266-6683

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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